Selecting Patients for Immediate Cystectomy

[摘要] Management of high-grade urothelial carcinoma of the bladder involving the lamina propria (stage T1) but not penetrating into the muscularis propria represents a challenge for both physician and patient. There is no level I evidence to direct us. Transurethral resection (TUR) has long been recognized as an inadequate complete treatment, with recurrence rates approaching 80% and the risk of progression to muscle invasion approaching 60%.1,2 Adjuvant intravesical therapy with Bacille Calmette-Guérin (BCG) or chemotherapeutic agents, such as mitomycin C, may decrease the overall recurrence rate by approximately 30% compared with TUR alone,3,4 but tumor progression still occurs in 15% to 40% of patients within the first 5 years, and these patients are at risk of dying from urothelial cancer.4,5 It remains difficult to accurately identify life-threatening, high-grade T1 tumors. Multiple tumors, larger size (more than 3 cm), carcinoma in situ (CIS), and tumor at first follow-up cystoscopy after treatment are associated with greater risk of disease progression and reduced survival. Other prognostic factors under investigation are lymphovascular invasion, depth of lamina propria invasion, and tumor marker expression.6–8

[学科分类] 基础医学